Abstract

OBJECTIVE—The aim of this study was to examine the relationships between intention to lose weight, actual weight loss, and all-cause
mortality among overweight individuals with diabetes.

RESEARCH DESIGN AND METHODS— We performed a prospective analysis among 1,401 overweight diabetic adults aged ≥35 years sampled in the National Health
Interview Survey. The previous year intention to lose weight and weight change were assessed by self-report. Nine-year mortality
rates were examined according to intent to lose weight and weight loss, which were adjusted for age, sex, education, ethnicity,
smoking, initial body weight, and diabetes complications.

RESULTS—Individuals trying to lose weight had a 23% lower mortality rate (hazard rate ratio [HRR] 0.77, 95% CI 0.61–0.99) than those
who reported not trying to lose weight. This association was as strong for those who failed to lose weight (0.72, 0.55–0.96)
as for those who succeeded in losing weight (0.83, 0.63–1.08). Trying to lose weight was beneficial for overweight (BMI 25–30
kg/m2) individuals (0.62, 0.46–0.83) but not for obese (BMI >30) individuals (1.17, 0.72–1.92). Overall weight loss, without regard
to intent, was associated with an increase of 22% (1.22, 0.99–1.50) in the mortality rate. This increase was largely explained
by unintentional weight loss, which was associated with a 58% (1.58, 1.08–2.31) higher mortality rate.

CONCLUSIONS—Overweight diabetic adults trying to lose weight have a reduced risk of all-cause mortality, independent of whether they
lose weight. Actual weight loss is associated with increased mortality only if the weight loss is unintentional.